Total Parenteral Nutrition

Complex Nutrition Clinic

Patient Information Sheet on Total Parenteral Nutrition

דף מידע למטופלים בנושא הזנה תוך-ורידית

TPN (Total Parenteral Nutrition)

Dear Patient,

The information sheet is designed to help you become familiar with intravenous nutrition therapy, so you will be aware of what is required during the treatment period. This sheet is a supplement to the guidance you will receive from the medical team and should help you effectively follow the medical instructions.

What is intravenous nutrition?

Intravenous nutrition is a feeding method used in patients with impaired digestive system function, a condition that occurs for various reasons when the digestive system is unable to properly absorb or break down nutrients found in food. For some patients, intravenous nutrition is a temporary treatment, but in certain cases this type of nutrition is a permanent and primary means of feeding.

Intravenous nutrition is called TPN in professional terms, an abbreviation of: Total Parenteral Nutrition.

When administering TPN, the digestive system is bypassed and nutrition is provided directly into the bloodstream. Intravenous nutrition includes all the daily nutritional components that the body needs: carbohydrates, fats, proteins, vitamins, electrolytes and fluids. The TPN is given in a controlled manner while providing specific amounts of energy and nutrients.

You will receive precise instructions regarding the frequency of treatment from your medical team – sometimes intravenous nutrition is given daily and sometimes only a few times a week. In some cases, parenteral nutrition (TPN) will be given in combination with regular oral feeding.

Who prepares the TPN solution?

The pharmacy staff prepares the solutions for you following to a specific medical prescription. The intravenous nutrition dose is individually adjusted for each patient as assessed by a dietitian and specialist physicians.

How is the solution delivered to the body?

The solution is given through a special catheter placed in one of the central veins in the body. During your hospital stay, a central catheter will be inserted through which you will receive the nutrition. The catheter is usually placed in the upper arm – this is called a PICC LINE, and sometimes a different type of catheter will be inserted in the chest area, called a HICKMAN.

The bag containing the solution will be connected to the catheter through a sterile tube. To ensure the solution is infused into the body in a controlled and precise manner every hour according to medical instructions, a special infusion pump is used, both in the hospital and at home. The machine is programmed to regulate the infusion rate automatically, so that the amount gradually increases at the beginning of the infusion and decreases towards the end, according to the pre-determined protocol, without needing your intervention.

Important to remember!

• Use new supplies (infusion sets) every day to infuse the solution into the bloodstream.
• Make sure to change the dressing on the central catheter and have the attached caps replaced weekly or sooner if the dressing becomes worn or separated from the skin. The replacement is usually placed by a nurse.
• Do not inject any additional material into the solution.

What information should you give your doctor before starting TPN?

Your doctor should be informed of your detailed medical history, including health problems such as diabetes, liver disease, kidney disease, bone mass problems, and any known allergies.

Your doctor should also be informed about any medications you are taking, including vitamins, supplements, or herbal remedies.

How to continue treatment at home after discharge from the hospital?

Before being discharged to continue TPN treatment at home, a specialist nurse will instruct you on how to use the nutrition solution, and how to connect and disconnect from the central catheter. If you have forgotten to receive a dose or if the connection times change, contact the service provider’s help center, which is available 24/7 for advice, guidance, and service.

• Make sure you understand the treatment instructions before use and that you follow them.
• If there is leakage from the catheter or tube or there is a problem with the nutrition bag, contact the service provider immediately at the following numbers:

HomeCure – phone number: 1-800-30-68-68

Remedix – phone number: 1-800-600-700

• It is vital to maintain hygiene throughout the treatment period and follow the treatment team’s instructions.

Who can help during the treatment at home?

If you need support and assistance, you can contact the following:

1. The help center of the company providing your nutrition solution – When you begin treatment at home, you will be given contact information for company representatives who can answer urgent questions over the phone related to operating the pump and connecting the nutrition bag. They will also provide you with the pump, solution, and necessary equipment.
2. Family doctor and kupat holim clinic – When you are discharged from the hospital, you will be asked to come to the kupat holim clinic several times as instructed by the team for follow-up blood tests, which will include: blood count, full biochemistry including kidney and liver function, magnesium, calcium, phosphorus, vitamins (folic acid, Vitamin D, Vitamin B12), zinc, fats including triglycerides. In addition, you will need to contact the primary clinic/kupat holim clinic to receive payment voucher forms for the Complex Nutrition Clinic at Hadassah:

Please bring two payment voucher forms from the kupat holim:

Voucher for the gastroenterologist – code L9257

Voucher for a dietitian – code 97802

3.Complex Nutrition Clinic at Hadassah Ein Kerem Medical Center – The clinic team will monitor your condition during periodic visits to the clinic.

We, the multidisciplinary team at the clinic, are available to answer any questions you may have and are ready to assist you with whatever is needed. If necessary, we will ask you to send us up-to-date blood tests after your discharge, which will be taken at your kupat holim clinic.

When will I receive the solution and the necessary equipment?

The service company will contact you or a family member during your hospitalization before discharge and provide you with the ordered solution bags and other necessary equipment. These will be delivered to your home regularly in coordination with you. Please note:

• Upon receiving the supply, check the label on the solution bag: make sure your name is listed, check that the expiration date is correct, and ensure that the bag is intact and undamaged.
• Store the solution in the refrigerator at a temperature of 2 - 5 degrees Celsius.
• Keep the nutrition solution bag in a closed place away from heat or light.
• Remove the nutrition solution bag from the refrigerator about two hours before connecting so that it is at room temperature when used.
• Keep the equipment out of reach of children or pets.

Will my daily functioning and lifestyle change as a result of the treatment?

The aim of home treatment is to maintain a normal lifestyle as much as possible.

The solution is infused at hours that suit you, and you can connect to it at any time during the day – morning, evening or night. Choosing a nighttime infusion allows you freedom of movement during the day according to your routine and activities.

Instructions for maintaining the PICC line and HICKMAN catheter at home

• Keep the catheter area clean and dry at all times.
• Before showering, wrap the area in plastic wrap and secure it tightly with an adhesive bandage to prevent water from entering.
• It is important to completely avoid going into the sea, pool or mikveh (ritual bath).
• In the event of redness, pain or fever in the catheter area – immediately contact your kupat holim and our clinic nurse.

We encourage you to continue living your regular lifestyle, stay in touch with family and friends, and continue activities that you enjoy.

What should I be especially aware of during the treatment period?

Be aware of symptoms that require immediate attention:

• Local reaction at the catheter site, such as: itching, redness, local warmth or swelling
• Confusion
• Fainting
• Fever (above 38° C.)
• Chills
• New weakness
• Sudden change in medical condition

In the event any of the above symptoms occur:

1. Do not stop TPN treatment suddenly.
2. Contact the company service center or kupat holim immediately.
3. Contact our clinic team by email.
4. In severe cases – go immediately to the nearest emergency room and inform the medical team about your TPN treatment.

Complex Nutrition Clinic at Hadassah Ein Kerem:

Upon your discharge from the hospital, you will be scheduled for an appointment at the Complex Nutrition Clinic at Hadassah Ein Kerem for follow-up and continued treatment.

The appointment will be scheduled in advance – the clinic is open on Tuesdays from 10:00 to 14:00.

The clinic is located in Hadassah Ein Kerem, in the Sharett Institute building, floor –1.

For questions, inquiries and updates, you can contact the TPN Nurse Coordinator – Mira Zoll, at phone number: 050-8946644.

Or by email: [email protected]

Please note! You must have the required voucher forms and up-to-date blood tests from the kupat holim when you arrive at the clinic for your appointment.

We wish you success with your treatment and a speedy recovery!

Complex Nutrition Clinic Team, Hadassah Ein Kerem

Written by: Mira Zoll, TPN Nurse Coordinator, Complex Nutrition Clinic

Edited by: Marva Farhod, Patient Education Coordinator, Quality and Safety Division

The information in this publication is intended for education only and does not constitute a medical opinion and under no circumstances does it replace professional medical advice. All rights reserved to Hadassah ©. Do not photocopy, duplicate and use commercially without written approval from Hadassah. 2025. Additional Hadassah information sheets are available for review on its website: www.hadassah.org.il